In bioethics, the predominant categorization of various types of influence has been a tripartite classification of rational persuasion (meaning influence by reason and argument), coercion (meaning influence by irresistible threats—or on a few accounts, offers), and manipulation (meaning everything in between). The standard ethical analysis in bioethics has been that rational persuasion is always permissible, and coercion is almost always impermissible save a few cases such as imminent threat to self or others. However, many forms of influence fall into the (...) broad middle terrain—and this terrain is in desperate need of conceptual refining and ethical analysis in light of recent interest in using principles from behavioral science to influence health decisions and behaviors. This paper aims to address the neglected space between rational persuasion and coercion in bioethics. First, I argue for conceptual revisions that include removing the “manipulation” label and relabeling this space “nonargumentative]influence,” with two subtypes: “reason-bypassing” and “reason-countering.” Second, I argue that bioethicists have made the mistake of relying heavily on the conceptual categories themselves for normative work and instead should assess the ethical permissibility of a particular instance of influence by asking several key ethical questions, which I elucidate, that relate to (1) the impact of the form of influence on autonomy and (2) the relationship between the influencer and the influenced. Finally, I apply my analysis to two examples of nonargumentative influence in health care and health policy: (1) governmental agencies such as the Food and Drug Administration (FDA) trying to influence the public to be healthier using nonargumentative measures such as vivid images on cigarette packages to make more salient the negative effects of smoking, and (2) a physician framing a surgery in terms of survival rates instead of mortality rates to influence her patient to consent to the surgery. (shrink)

Andreas Schmidt argues that ethicists have misplaced moral qualms about nudges insofar as their worries are about whether nudges treat us as rational agents, because nudges can enhance our rational agency. I think that Schmidt is right that nudges often enhance our rational agency; in fact, we can carry his conclusion further: nudges often enhance our self-governing agency, too. But this does not alleviate our worries that nudges fail to treat us as rational. This is shown by disambiguating two conceptions (...) of treating-as-rational. The more plausible conception of treating-as-rational undermines Schmidt’s case that nudges often treat us as rational. (shrink)

The nudge approach seeks to improve people’s decisions through small changes in their choice environments. Nudge policies often work through psychological mechanisms that deviate from traditional notions of rationality. Because of that, some critics object that nudging treats people as irrational. Such treatment might be disrespectful in itself and might crowd out more empowering policies. I defend nudging against these objections. By defending a nonstandard, ecological model of rationality, I argue that nudging not only is compatible with rational agency but (...) can even support it. Accordingly, a concern with rationality speaks for more rather than less public policy nudging. (shrink)

In their recently published book Nudge (2008) Richard H. Thaler and Cass R. Sunstein (T&S) defend a position labelled as ‘libertarian paternalism’. Their thinking appeals to both the right and the left of the political spectrum, as evidenced by the bedfellows they keep on either side of the Atlantic. In the US, they have advised Barack Obama, while, in the UK, they were welcomed with open arms by the David Cameron's camp (Chakrabortty 2008). I will consider the following questions. What (...) is Nudge? How is it different from social advertisement? Does Nudge induce genuine preference change? Does Nudge build moral character? Is there a moral difference between the use of Nudge as opposed to subliminal images to reach policy objectives? And what are the moral constraints on Nudge? (shrink)

According to a number of influential views in penal theory, 1 one of the primary goals of the criminal justice system is to rehabilitate offenders. Rehabilitativemeasures are commonly included as a part of a criminal sentence. For example, in some jurisdictions judges may order violent offenders to attend anger management classes or to undergo cognitive behavioural therapy as a part of their sentences. In a limited number of cases, neurointerventions — interventions that exert a direct biological effect on the brain (...) — have been used as aids to rehabilitation, typically being imposed as part of criminal sentences, separate treatment orders, or conditions of parole. Examples of such interventions include medications intended to attenuate addictive desires in substance-abusing offenders and agents intended to suppress libido in sex offenders.This chapter reviews some of the ethical issues raised by the use of neurointerventions as aids to rehabilitation. (shrink)

Too often, we as individuals do things that harm us, that seriously interfere with our being able to live in the way that we want. We eat food that makes us obese, that promotes diabetes, heart failure and other serious illness, while at the same time, we want to live long and healthy lives. Too many of us smoke cigarettes, even while acknowledging we wish we had never begun. We behave in ways that undercut our ability to reach some of (...) our most valued goals, despite education and despite incentives to choose the right thing. What should be done?If I were to try to harm someone else in a way that alters his future seriously and perhaps irrevocably for the worse, I would be stopped. When it comes to hurting myself, though, we have a common belief that it is wrong to interfere, even if I foresee that I will very much regret what I have done, often when it is too late to fix what I have let happen. I think this makes no sense. If it is permissible, even obligatory, to stop me when I do something that seriously interferes with someone else's chances of achieving the life he wants, I think …. (shrink)

Since Mill's seminal work On Liberty, philosophers and political theorists have accepted that we should respect the decisions of individual agents when those decisions affect no one other than themselves. Indeed, to respect autonomy is often understood to be the chief way to bear witness to the intrinsic value of persons. In this book, Sarah Conly rejects the idea of autonomy as inviolable. Drawing on sources from behavioural economics and social psychology, she argues that we are so often irrational in (...) making our decisions that our autonomous choices often undercut the achievement of our own goals. Thus in many cases it would advance our goals more effectively if government were to prevent us from acting in accordance with our decisions. Her argument challenges widely held views of moral agency, democratic values and the public/private distinction, and will interest readers in ethics, political philosophy, political theory and philosophy of law. (shrink)

The unconscionability doctrine in contract law enables a court to decline to enforce a contract whose terms are seriously one-sided, exploitative, or otherwise manifestly unfair. It is often criticized for being paternalist. The essay argues that the characterization of unconscionability doctrine as paternalist reflects common but misleading thought about paternalism and obscures more important issues about autonomy and social connection. The defense responds to another criticism: that unconscionability doctrine is an inappropriate, because economically inefficient, egalitarian tool. The final part discusses (...) more interesting but neglected questions about the scope of accommodation necessary to support fully meaningful autonomous activity. (shrink)

The present book makes a particularly engaging case for a whole range of policy implications of behavioural economics. The rhetoric is highly compelling, and their approach is already having a significant impact. However, while the wider audience for whom the book is written may not be interested in the justification of the underlying principles, it is precisely the cracks in the foundations that pose the greatest threat to the project. For example, if Thaler and Sunstein are to have any chance (...) of their 'libertarian paternalism' meriting ‘libertarian’ credentials, it is essential that the re-engineering of choice architecture not be guided by any particular political or moral agenda. Their claim here is that what makes a nudge beneficial is not that it steers people in the direction of behaviour that is objectively ‘good’ but rather in the direction of behaviour that they won’t regret. That said, there are a number of points where it is hard to shake the suspicion that Thaler and Sunstein help themselves rather conveniently to the idea that, if a person’s choices are largely a function of various framing effects, say, then overriding those choices violates no autonomy, since there was no autonomy there to be violated. -/- In this review, I raise four concerns not adequately addressed in the book. -/- (1) Thaler and Sunstein are misleading in their use of the term ‘paternalism’, which is standardly defined as a matter of interfering with a competent person’s choices out of a motivation to improve that person’s welfare. As Thaler and Sunstein use the term, however, it becomes equivalent to beneficence: when the government acts to improve people’s welfare by influencing choices in any way, according to them, it is engaging in paternalism. -/- (2) Their appeal to the resistibility of nudges is a centrepiece of the account and particularly of its claim to be ‘libertarian’, but given what they themselves write about how effective nudges are and how poor we are at even noticing the influences to which we are subject, it is entirely unclear why we should expect nudges to be easily resisted. -/- (3) Thaler and Sunstein generally align themselves with the perspective of planners who half-pose the presumptuously rhetorical question, ‘Who would really mind?’ But the question is not just whether people would object, if they were consulted. People also care about whether they are consulted and whether they understand the influences to which they are subject. Thaler and Sunstein advise choice architects against being secretive about nudges, but this espousal of principle, in a late chapter responding to objections, is not borne out by the discussion in the rest of the book, which focuses almost exclusively and rather effusively on the possibilities for channelling individuals’ choice-behaviour toward better outcomes. -/- (4) Thaler and Sunstein tend to downplay alternative approaches to improving decision making that are perfectly compatible with the behavioural economics and social psychology discussed by Thaler and Sunstein, but less paternalistic. For example, there is a growing body of research on how to construct contexts of interpersonal deliberation to generate stable solutions to collective action problems, by improving people’s collective decision-making capacities, rather than subjecting them to nudges. More generally, one comes up with very different recommendations if one thinks of the problems to which nudges are supposed to be a solution not as a matter of human failings per se, but rather as a socially and historically contingent misfit between the decision-making capacities that particular policies and institutions require of individuals and the capacities that people actually have. Conceived in the latter way – in terms of what I have elsewhere dubbed ‘autonomy gaps’, it becomes an open question whether what is called for is a choice architecture that makes it easier to avoid regrettable decisions or, rather, various measures to improve individuals’ decision-making capacities, say, through education, ‘buddy’ arrangements, decision-making heuristics, etc. (shrink)

Liberalism without Perfection offers an introduction to the debate between liberal perfectionism and political liberalism. This book is a new account and defence of Rawlsian political liberalism, one of the most discussed, but widely misunderstood and criticized theories in contemporary political theory.

I am to grateful to Geoff Keeling for his perceptive response1 to my paper.2 In this brief reply, I will argue that he does not succeed in his goal of showing that nudges to reason do not respect autonomy. At most, he establishes only that such nudges may threaten autonomy when used in certain ways and in certain circumstances. As I will show, this is not a conclusion that should give us grounds for particular concerns about nudges. Before turning to (...) this issue, let me correct some small issues of interpretation of my paper. Keeling takes me to be committed to three descriptive claims: that we have entered a post-truth era, that our problem with the rational assessment of evidence is explained by or stems from the backfire effect and that nudges to reason work by exploiting affective mechanisms. I am not committed to accepting any of these claims. …. (shrink)

It is generally wrong to manipulate. One leading reason is because manipulation interferes with autonomy, in particular the component of autonomy called ‘independence’, that is, freedom from intentional control by others. Manipulative health promotion would therefore seem wrong. However, manipulative techniques could be used to counter-manipulation, for example, playing on male fears of impotence to counter ‘smoking is sexy’ advertisements. What difference does it make to the ethics of manipulation when it is counter-manipulation? This article distinguishes two powerful defences of (...) counter-manipulative health promotion: that the counter-manipulation would prevent manipulation occurring, leaving people unmanipulated; and that the counter-manipulation would make people healthier without being any more manipulated than they would otherwise be. The article explains how counter-manipulation might work and the limits to its scope. The upshot is that counter-manipulative health promotion could respect the independence people are owed in virtue of their autonomy. However, autonomy is not the only consideration, and the article discusses further potential problems. Counter-manipulative health promotion might be misapplied, it might undermine trust, it might infringe on some norms for role behaviour and it might encourage a regrettable social practice. These objections are likely to be decisive against the counter-manipulation in some but not all cases. (shrink)

I argue that rationally persuading another to do something for their own good is sometimes (objectionably) paternalistic. Rational persuasion may express, and be guided by, the motive of distrust in the other’s capacity to gather or weigh evidence, and may intrude on the other’s deliberative activities in ways that conflict with respecting their agency and autonomy. I also examine factors that make a difference to whether (and when) the provision of reasons is respectful.

Libertarian paternalism's notion of “nudging” refers to steering individual decision making so as to make choosers better off without breaching their free choice. If successful, this may offer an ideal synthesis between the duty to respect patient autonomy and that of beneficence, which at times favors paternalistic influence. A growing body of literature attempts to assess the merits of nudging in health care. However, this literature deals almost exclusively with health policy, while the question of the potential benefit of nudging (...) for the practice of informed consent has escaped systematic analysis. This article focuses on this question. While it concedes that nudging could amount to improper exploitation of cognitive weaknesses, it defends the practice of nudging in a wide range of other conditions. The conclusion is that, when ethically legitimate, nudging offers an important new paradigm for informed consent, with a special potential to overcome the classical dilemma between paternalistic beneficence and respect for autonomy. (shrink)